Healthcare Provider Details

I. General information

NPI: 1225948219
Provider Name (Legal Business Name): AIZHAMAL RACHAEL THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE RACHAEL THOMAS

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8140 ASHTON AVE STE 112
MANASSAS VA
20109-5699
US

IV. Provider business mailing address

3108 E LEIGH ST
RICHMOND VA
23223-7442
US

V. Phone/Fax

Practice location:
  • Phone: 571-201-1955
  • Fax:
Mailing address:
  • Phone: 703-431-2856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: